Ripple effects seen in families plunged into insecurity

Action Points

Note that this longitudinal analysis found that children who have food insecurity continuously had less behavioral problems than those who became food insecure.

Be aware that these assessments were only performed in kindergarten and first grade.

Children who suddenly become "food insecure" are likely to show more behavioral problems, even in comparison with children who are used to being hungry, according to data from the Early Childhood Longitudinal Study.

In adjusted analyses, children who transitioned from being adequately fed in kindergarten ("food security") into being hungry in first grade ("food insecurity") received lower scores on interpersonal skills, self-control, externalizing behaviors, and health outcomes compared to children who were hungry in both grades, reported Rachel Tolbert Kimbro, PhD, and Justin T. Denney, PhD, both of Rice University in Houston.

These children were also associated with a statistically significant difference in interpersonal skills (-0.17, SE 0.05), self-control (-0.17, SE 0.04), and externalizing behaviors (-0.13, SE 0.04; P<0.001 for all) compared to children who were adequately fed during both grades, they wrote in Health Affairs.

Kimbro told MedPage Today that she was surprised by these results, as she might have expected children who were food insecure for a longer period of time to have worse outcomes. But she added that maybe a family who was in that state for a prolonged period of time found a way to ameliorate that impact on their kids.

In fact, children who were food insecure during waves of the study only scored lower on externalizing behaviors (-0.12, SE 0.03, P<0.001). Those who transitioned into food insecurity also experienced worse health outcomes than those who were food insecure at both times, but both were statistically significant compared to adequately fed children (-0.18, SE 0.05, P<0.001 and -0.15, SE 0.05, P<0.01, respectively).

Sarah Jane Schwarzenberg, MD, the lead author of the AAP statement, told MedPage Today in an email that these findings reminded her of the "fluid nature" of food insecurity, which makes repeated screening helpful in understanding the impact on children.

"The more we learn about the impact of food insecurity on children' s health, the more important it is to screen," said Schwarzenberg, who was not involved with the study. "This not only allows the pediatrician to direct families to food resources, but may inform educators in managing children in the classroom who have experienced food insecurity -- that is, perhaps we should be looking at strategies to help children who have experienced food insecurity overcome behavioral problems."

Interestingly, while academic outcomes were lower both for kids who became hungry in first grade and those who were hungry during both grades, there were no statistically significant differences compared to kids who were adequately fed. Kimbro offered a possible explanation for the difference.

"To me, there's an indication that there's been a change -- that maybe a parent has lost a job or the family has been evicted and that shows up not in the academic outcomes, but in the behavioral outcomes," she said.

Overall, children who experienced food insecurity were more likely to have a foreign-born parent, a younger mother, lower socioeconomic status, and more siblings in the household. They were less likely to be non-Hispanic white and to live at home with two biological parents.

The Early Childhood Longitudinal Study is a nationally representative sample, which used data from 6,300 children in the kindergarten class of 2010-2011 with household incomes below 300% of the federal poverty level. Data was collected via parent interview, as well as assessments of the child from teachers and school administrators.

Limitations to the study include that assessments were limited to children in kindergarten and first grade, and only eight factors were used to measure well-being. The authors also noted potential unobserved confounders that may have impacted the results, and that they used household food insecurity instead of a specific measure of food insecurity among children.

Kimbro said that the study was ongoing, so they would have a chance to see if there were more long-term impacts of hunger. She emphasized the important role of clinicians in detecting potential food insecurity in their patients.

"Pediatricians need to be aware of changes in their patients and what is going on in the family, because that could result in food insecurity for the family in ways that are more impactful for the kids," she concluded.

This study was supported with grants from the University of Kentucky Center for Poverty Research through funding from the Food and Nutrition Service of the Department of Agriculture, the Young Scholars Program of the Foundation for Child Development, and the Baker Institute for Public Policy's Program in Health Economics.

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